Updated cannulation technique for tissue plasminogen activator injection into peripapillary retinal vein for central retinal vein occlusion

Purpose To update the surgical technique in which a vitrectomy is performed and a retinal branch vein is cannulated and infused with recombinant tissue plasminogen activator ( RTPA ) to treat central retinal vein occlusion ( CRVO ) in patients who present with very low visual acuity ( VA ). Methods Twelve consecutive patients (12 eyes) with CRVO and low VA (log MAR >1.00) at presentation were treated using this method. Results Cannulation of a peripapillary retinal vein and stable injection of RTPA was successfully performed without surgery‐related complications in all 12 eyes. At 12 months after surgery, 8 of the 12 patients (67%) experienced at least one line of improvement in best corrected visual acuity; 6 of the 12 (50%) improved ≥5 lines and 2 (17%) improved ≥8 lines. After additional grid laser and/or subconjunctival or intravitreal corticosteroids, the mean decrease in central foveal thickness was 260  μ m, and the mean total macular volume decreased from 12.10 mm 3 to 9.24 mm 3 . Four patients received panretinal photocoagulation to treat either iris neovascularization ( n  = 2) or neovascularization of the retina and/or disc ( n  = 2). Conclusion Administration of RTPA via a peripapillary vein using this updated technique provides an alternative or additional treatment option for patients with very low VA after CRVO .